| NPI | 1881740405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2009-01113) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1893) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2009-01113) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2015-02-13 |